Diabetes is a metabolic disorder caused by abnormal release of or sensitivity to the insulin hormone, with loss of blood glucose control. Un controlled diabetes can have devastating effects on many organ systems including cardiovascular, neurologic, ocular, and renal, with its impact on skin, hair, and nail. diabetes mellitus is a predisposing factor for onychomycosis (OM),paronychia and ingrowing toe nail defects. In the present study evaluation of the prevalence and types of nail changes was done. Materials and Methods: During a 1 year study period (June 2018 to May 2019), patients with diabetes mellitus were screened for toenail changes. Demographic, social, and clinical data were recorded. Informed written consent was taken. Fungal infection was confirmed by nail clippings microscopy. Results: Of the 60 patients most common nail changes are subungual hyperkeratosis, onycholysis, and onychomycosis, and less common changes are Twenty nail dystrophy, Dorsal pterygium, Terry's nail in liver disease and diabetes mellitus and Subungual wart. Conclusions: Physicians who care for diabetic patients should not ignore nail changes. Careful global evaluation of patients with diabetes should include observation of nail changes.
INTRODUCTION: There is no study in literature for analyzing acanthosis nigricans (AN) in psychotropic induced obesity or hypercholesterolemia. AIM: To assess the prevalence and explore the predictors and morphological patterns in AN in patients on antipsychotics induced hypercholesterolemia versus those with diabetes mellitus. MATERIALS AND METHODS: 491 schizophrenia patients on second generation antipsychotics were screened. 26 out of 491 patients have AN and cholesterol 200 mg/dl but non-diabetic. We used MannWhitney U-test, Pearsons 2 test, Fischer Exact and Spearmans correlation coefficient. RESULTS: In the group of antipsychotics induced hypercholesterolemia having developed AN in 5.29% (26 out of 491) of individuals, we observed significance of Burkes knuckle (p 0.001), knee (p = 0.002), elbow (p = 0.042) compared to patients without hypercholesterolemia. Interestingly Burkes neck severity (p 0.001), neck texture (p = 0.001) and axilla (p = 0.007) index also showed marked differences on MannWhitney U-test and Wilcoxson W-test. On Spearmans correlation coefficient antipsychotics induced hypercholesterolemia was found to affect most positively and significantly as the emergence of AN specifically for neck texture ( = 0.413, p = 0.003) compared to other bodily regions. CONCLUSION: About 5.29% prevalence of AN in the group having obesity secondary to psychotropic drugs which was significantly less than what even non-obese, insulin dependent diabetic patients who almost had 13.55% prevalence, close to three times. This suggests that diabetes is strongly linked with occurrence of AN lesions and might reflect the continuity in the paradigm of metabolic syndrome as its definitive predictor of severity while obesity is the initiation of phase shift in the process.
Introduction: Metabolic syndrome is a cluster of metabolic risk factors which includes central obesity, glucose intolerance, hyperinsulinemia, low HDL cholesterol, high triglycerides and hypertension. Acanthosis nigricans, the principal abnormality in metabolic syndrome (MetS), is an easily identifiable asymptomatic non-specific reaction pattern of skin characterized by thickened, hyperpigmented plaques associated with hyperinsulinemia. Aims and Objectives: To determine the prevalence of metabolic syndrome and AN in adolescent and adults and the association between benign acquired AN and metabolic syndrome. Materials and Methods: A sample of 40 patients selected from Dermatology outpatient department who satisfied the selection criteria to evaluate the prevalence of AN and its association with insulin resistance and the clustering of the MetS components. Epidemiological, clinical and anthropometric characteristics (height, weight, waist circumference) were measured and BMI was calculated. We used the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria for the diagnosis of metabolic syndrome. Results: The average age of the study population was 26.8 years, with male to female ratio of 1:1. The prevalence of acanthosis nigricans among females is greater than males, which also showed a positive correlation with increase in the age. BMI was higher in patients with metabolic syndrome than the patients without metabolic syndrome.There was a statistically significant correlation of increasing incidence of AN with each component of metabolic syndrome. Conclusion: There is an increased prevalence of MetS in the individuals with AN which was statistically highly significant. Hence, early screening of a simple clinical marker like AN is helpful in identification of MetS components.
Blood flow was s t u d i e d hy venous occlusion plethysmoeraphy i n 1 3 i n f a n t s r g q u i r i n g e i t h e r continuous p o s i t i v e airwhy p r e s s u r e (CPAP) o r a s s i s t e d v e n t i l a t i o n f o r hyaline vembrhne d i s e a s e .I n f a t s were s t u d i e d a t one t o 5 days of age. Ind i v i d u a l i n f a n t s were s t u d i e d on up t o 4 d i f f e r e n t days. The system used c o n s i s t e d of a blood pressure cuff a p p l i e d t o t h e t h i g h and a mercury strxain gauge a p p l i e d c i r c u m f e r e n t i a l l y t o t h e mid-calf (Kidd e t a l , 1966). A r t e r i a l blooc pressure (EP) was measured d i r e c t l y . Venous occlusion was accomplished ky i n f l a t i n g t h e c u f f t o a pressure below t h a t of t h e d i a s t o l i c BP. Blood flow ranged from 3.8 t o 14.2 r n l / l C O gnl of t i s s u e / minute. For each i n f a n t , values were reproducikle on a giver. day, but l a b i l e from day t o day. The observed values were h i g h e r t h a n t h o s e r e p o r t e d by Kidd e t a l , p o s s i b l y becduse of changing p r a c t i c e s regarding intravencus f l u i d s and blood t r a n s f u s i o n . Changes i n blood flow could not be p r e d i c t e d from changes i n BP, c e n t r a l h e c a t o c r i t , o r volume of blood withdrawn f o r l a b o r a t o r y s t u d i e s . Blood l a c t a t e , base d e f i c i t o r requirements f o r intravenous bicarbonate could not be pred i c t e d from bloo6 flow. CPAP a t p r e s s u r e s up t o 6 cm Hz0 d i d not s i g n i f i c a n t l y reduce blood flow. A low blood flow i n t h e f i r s t 24 hours suggested t h a t blooC t r a n s f u s i o n wasmorelrkely t o be r e q u i r e d subsequently during t h e course of t h e ?isease.PULMONARY BLOOD FLOW (PBF) I N LAMBS WITH HYALINE MEMBRANE DISEASE (HMD). Alexander C. Allen, Dora A . Stinson, Hugh M. MacDonald and Paul M. Taylor. Univ. of P i t t s b u r g h Sch. of Med. Maaee-Womens Hosp., Dept. of P e d i a t r i c s , P i t t s b u r g h , Pa.-~f f e c t i v e P B F '~~ lo" during t h e course of HMD (~h u e t a l , P e d i a t r i c s , s : 7 3 3 , 1965). I t i s not known whether t h i s change i s c e n t r a l i n t h e e t i o l o g i c chain of events o r simply a secondary phenomenon. T o t a l PBF was measured during t h e f i r s t 4 h r of l i f e i n lambs with and without HMD.At 129-133 days' g e s t a t i o n a pre-calibrated electromagnetic flow transducer w i t h non-occlusive zero was implanted on the p o s t d u c t a l port i o n of t h e comnon pulmonary a r t e r y of 8 f e t a l lambs which were r e t u r n e d t o t h e amniotic c a v i t y f o r 7 days and then del i v e r e d by C-section a t 136-140 days' g e s t a t i o n . A f t e r b i r t h a Swan-Ganz c a t h e t e r was f l o a t e d i n t o a branch pulmonary a rt e r y f o r pressure measurements. By c l i n i c a l and blood gas c r it e r i a , 4 lambs had no d i s t r e s s o r developed mild HMD; 4 developed moderate o r s e v e r e HMD. PBF increa...
Background and Aim: Chronic urticaria is a common distressing dermatosis characterized by spontaneous occurrence of wheals lasting for less than 24 hours, with or without angioedema occurring daily or almost daily for more than 6 weeks. The main aim of the present study is to investigate the positivity of ASST and clinical and severity in chronic idiopathic urticaria. Methodology: A total number of 100 cases of chronic idiopathic urticaria reporting to the Dermatology Venereology Leprology Department, Kamineni institute of medical sciences were studied. Results: 46 of them were females and 54 were males. Maximum cases were in the age group of 21-30 years (33%), followed by age group 31-40 years (26%). The age of the youngest patient was 14 years and that of the oldest was 65 years. Autoantibodies, detected by ASST, were seen in the sera of 43% patients with CIU, comparable to available reports in literature. Presence of autoantibodies was unrelated to gender and the mean age of onset of the disease was earlier in ASST positive patients. Presence of these autoantibodies was significantly associated with more duration of disease, more duration of wheal, frequent attacks of disease and UAS > 5. Angioedema and Abnormal Thyroid profile were significant in ASST positive patients. Dermographism occurred more frequently in ASST Negative patients. There was difference in presentation of clinical symptoms between ASST positive and negative patients but these were not statistically significant. There was difference in CBP, AEC, ESR, RBS Sr IgE Levels and ANA between positive and negative ASST patients, but these results were statistically insignificant. Conclusion: Thus, ASST identifies a sub group of patients with CIU with more severe disease, who are likely to be more symptomatic and would require more aggressive treatment.
Angioedema is a transient, non-pitting oedema that involves subcutaneous or submucosal tissue. Angioedema in children can have varied aetiology and clinical manifestations, unlike that in adults. We report a case of angioedema of penis in a child resulting from insect bite and treated successfully with anti-histamine and leukotriene inhibitor. Penile angioedema should be kept in mind as a differential diagnosis of penile swelling, as early diagnosis and management may prevent fatal complications.
Background: No single treatment for warts has proven 100% efficacy and most therapeutic modalities remain unsatisfactory. Immunotherapy with Measles-Mumps-Rubella (MMR) vaccine remains a key treatment of interest. The study done from August 2020 to March 2021 in the department of Dermatology, KIMS hospital, Narketpally. Telangana state. Objective: To evaluate the efficacy of intralesional MMR vaccine in the treatment of cutaneous warts in adults. Patients and Methods: Fifty patients (34 men and 16 women) aged 18-61 (mean ± standard deviation = 34.58 ± 11.74) years with common warts received 0.25 ml of MMR vaccine injected intralesionally in the largest wart. The dose was repeated at 2-week interval until complete clearance or for a maximum of 5 doses. Thereafter, they were followed up once a month for 24-week study period. The response was evaluated as complete clearance (complete disappearance of the wart(s) including distant ones and appearance of normal skin), partial clearance (≤99% reduction in size and number including distant ones and few residual warts still visible), good response (some reduction in size only including that of distant ones but no decrease in number of warts), or poor response (no change in size and number). Results: 50 patients completed the study and 29 (58%) of them had complete clearance of warts, 14 (28%) showed partial clearance and 5 (10%) patients showed good response. Complete clearance of warts occurred after five doses in 19 (38%) patients and after 4 doses in 9 (18%) patients. Conclusion: MMR vaccine is a promising treatment modality for common warts, particularly the multiple and recalcitrant ones. It seems to be inexpensive, effective and safe option that has the potential advantages of widespread and sustained effects against HPV. Intralesional MMR also appears to be much less painful and safe than traditional destructive methods for wart treatment, and thus seems to be better tolerated.
Dermatoses in neonatal period is very common and important cause of parental anxiety seeking dermatologist or paediatric consultation.To study the clinical profile of neonatal dermatoses in a tertiary care centerm A cross-sectional study on cutaneous lesions in 200 newborns was conducted from October 2016 to September 2018 in the department of dermatology at KIMS Hospital, Narketpally. Male: Female ratio of skin lesions was 1.22:1. Physiological skin lesions were seen in 186 babies followed by pathological skin lesions in 44 babies. Mongolian spot (93%), physiological scaling (83%), were commonest physiological skin lesions seen in the study. Pathological lesions were seen among 73(36.5%) babies.
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